Relationship between Corneal Guttae and Quality of Vision in Patients with Mild Fuchs' Endothelial Corneal Dystrophy

Purpose To investigate the effect of the severity of corneal guttae on quality of vision (QOV) in patients with mild Fuchs' endothelial corneal dystrophy (FECD). Design Cross-sectional study. Participants Twenty-three eyes of 14 patients with mild FECD without corneal edema on slit-lamp examination (5 pseudophakic eyes and 18 phakic eyes with mild lens opacity; grade 1.0–2.0 nuclear opalescence, grade 1.0–2.0 nuclear color, grade 1.0 cortical cataract, and grade 1.0 posterior subcapsular cataract on the Lens Opacities Classification System, version III). Methods The area ratio of the corneal guttae (ARCG) in the endothelial cells was measured by multifocal specular microscopy. The QOV parameters, that is, corrected distance visual acuity (CDVA), letter contrast sensitivity (LCS), and intraocular straylight, also were measured. The correlations were assessed between the ARCG and QOV parameters and between the straylight and CDVA and LCS. Main Outcome Measures The ARCG, logarithm of the minimum angle of resolution CDVA, LCS, and straylight. Results Univariate analysis showed that the ARCG was correlated significantly with the CDVA, LCS, and straylight ( R 2  = 0.41, P  = 0.001; R 2  = 0.55, P  = 0.001; and R 2  = 0.39, P  = 0.002, respectively). Univariate analysis also showed that straylight was correlated significantly with the CDVA and LCS ( R 2  = 0.47, P  = 0.001 and R 2  = 0.41, P  = 0.001, respectively). Conclusions Corneal guttae without edema caused the QOV to deteriorate in eyes with FECD. Patients with higher straylight had worse CDVA or LCS. Intraocular forward light scatter caused by corneal guttae may result in visual disturbances. Quantification of corneal guttae can be useful to evaluate the effect of guttae on the QOV and determine the surgical indications of endothelial keratoplasty for eyes with mild FECD.